There’s a War on Sugar. Is It Justified? (Rebroadcast)

Some people argue that sugar should be regulated, like alcohol and tobacco, on the grounds that it’s addictive and toxic. How much sense does that make? We hear from a regulatory advocate, an evidence-based skeptic, a former F. D. A. commissioner — and the organizers of Milktoberfest.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Stephen J. Dubner?

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• 0:43Stephen J. Dubner?

  cutting down on the things you love, like those iced lattes that help you get ready to face the day. So switch your home and auto to Progressive and see if you could save and keep sipping away. Get your quote today at progressive.com. Progressive Casualty Insurance Company affiliates and other insurers. Not available in all states. Freakonomics Radio is sponsored by hotels.com. Hotels.com helps you find and book the right stay for work faster. With business preferences, save your travel must haves like gym access or breakfast just once, then get tailored results whenever you search for work travel. Plus, with a free membership, you can save up to 20% on hotels and earn rewards on every stay for future travel.

• 1:28Stephen J. Dubner?

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• 2:18Stephen J. Dubner?

  Hey there. It's Stephen Dubner. This week, we're playing you one of our most popular episodes from the archive because we're traveling. Our American listeners know why. To the rest of you, this is the week that Americans drive hundreds of miles to eat turkey, which isn't that great, honestly, and pie, which is great. So we thought it'd be a good time to re-release this episode, which is called "There's a War on Sugar: Is It Justified?" We'll be back next week with a new episode. If you can't wait that long, we've just put out four brand-new episodes of Freakonomics Radio Live on Stitcher Premium. In our live events, we have great guests and co-hosts and a live fact-checker, and

• 2:59Stephen J. Dubner?

  we all play a nonfiction game show called Tell Me Something I Don't Know. To hear four new episodes, go to stitcherpremium.com/freakonomics, use promo code FREAKONOMICS for one month free. As always, thanks for listening.

• 3:26Stephen J. Dubner?

  Surely, you are familiar with the beloved Autumn Festival that revolves around folk dancing and lots and lots of drinking.

• 3:32Speaker 01

  Milktoberfest, the holiday for drinking milk and doing homework.

• 3:38Stephen J. Dubner?

  Okay, not what you were expecting. Bavaria has Oktoberfest. Brigham Young University in Provo, Utah has Milktoberfest. Brigham Young being a Mormon university and therefore prohibiting the consumption of, among other substances, alcohol.

• 3:53Speaker 01

  People don't drink, but we still like to have a lot of fun.

• 3:56Stephen J. Dubner?

  Roger Layton, communications manager at the BYU Library, helps produce Milktoberfest.

• 4:01Speaker 01

  And so we just thought, let's just embrace that. Let's just enjoy it. We had a very energetic group of German folk dancers come in and perform. We brought in cases and cases of chocolate milk. And then as soon as the milk was there and we said, "Go," it basically became a free-for-all.

• 4:17Speaker 02

  I think people love it because it is sort of, kind of like Milktoberfest was almost like. You know, BYU Lite or something like that.

• 4:26Stephen J. Dubner?

  That's Brenna Oldroid. She's a BYU student who helped put together Milktoberfest.

• 4:31Speaker 02

  You know, like, hey, like, this is what we love to drink all the time.

• 4:36Stephen J. Dubner?

  The chocolate milk they're drinking isn't just any chocolate milk. It's some pretty legendary chocolate milk made in BYU's own creamery.

• 4:43Speaker 01

  You show up to the party with chocolate milk, no one's going to complain. I mean, it may seem a little childish, but really, people will drink it. It's friendly, it's safe, it's happy.

• 4:52Speaker 02

  And one of the great things about partying with chocolate milk is like, well, you probably, if you're smart, you're not going to throw up later, so that's a plus.

• 5:03Stephen J. Dubner?

  This all sounds pretty awesome, right? And wholesome, too. Swapping out beer for chocolate milk. But is chocolate milk really as wholesome as it seems? Do you know how much sugar there is in one cup of chocolate milk? The answer is 24 grams. That's a bit more than you'd find in the same amount of soda. And there are those who argue that the detriments of sugar, well, they'd argue that from a metabolic standpoint at least, Milktoberfest isn't much better than Oktoberfest.

• 5:34Speaker 03

  We started comparing what sugar did versus what alcohol did. And we realized, you know what? Sugar and alcohol do the exact same thing.

• 5:43Stephen J. Dubner?

  If you've been following health news in the last decade, you've likely noticed that there's a war on sugar.

• 5:49Speaker 04

  An alarming rise in the rate of obesity and related health problems has prompted a nationwide movement to ban or restrict sugary drinks.

• 5:57Stephen J. Dubner?

  How justified is that war? Today's episode was inspired by a question we received.

• 6:03Speaker 05

  Dear Freakonomics, my name is Saul Arno. I'm an 11-year-old listener from Chicago, and I was wondering why sugar isn't considered a drug, even though it's addictive and stimulates the brain. Sincerely, Saul.

• 6:17Stephen J. Dubner?

  Okay, Saul, we'll do our best to answer your question. Along the way, we will learn some sugar history.

• 6:23Speaker 06

  Thomas Aquinas, way back in the 13th century, he pronounced sugar a medicine.

• 6:29Stephen J. Dubner?

  We'll hear from some people who fully agree with you.

• 6:31Speaker 03

  Now, alcohol, tobacco, morphine, and heroin clearly meet these four criteria.

• 6:38Stephen J. Dubner?

  We'll also hear from some people who don't agree with you.

• 6:40Speaker 07

  We have no clue, no real good evidence, that it's going to do any good whatsoever.

• 6:46Stephen J. Dubner?

  And we'll hear all about your sugar habits.

• 6:51Speaker 08

  I tried to give it up once, but it didn't work out at all. Because I'm addicted to sugar, I can't help it.

• 6:57Speaker 09

  From Stitcher and Dubner Productions, this is Freakonomics Radio, the podcast that explores the hidden side of everything. Here's your host, Stephen Dubner.

• 7:24Stephen J. Dubner?

  Before we get into the nitty-gritty on sugar, let me offer a sort of caveat.

• 7:28Speaker 07

  In general, nutrition studies are not very robust compared to many other fields in biological science.

• 7:37Stephen J. Dubner?

  That's Richard Kahn.

• 7:38Speaker 07

  I'm the former chief scientific and medical officer of the American Diabetes Association.

• 7:43Stephen J. Dubner?

  So what's the problem with nutrition studies?

• 7:46Speaker 07

  There are often no controls, no randomization, a small number of subjects. It's very difficult to conduct very robust, long-term studies on nutrition.

• 7:56Stephen J. Dubner?

  Okay, this is a really important point, the kind of thing we talk about all the time on this program, the legitimacy of data, yada, yada. But with nutrition... There are a few things going on that make it particularly tough. Number one, this is about something that we all put in our mouths every day, which means we all think of ourselves as experts. Unlike particle physics or financial engineering, this is something we all do all the time. So of course, we know what we're talking about. Number two, most nutrition science is built on survey data. That is, asking people about what they've eaten or asking them to keep food diaries, things like that.

• 8:39Stephen J. Dubner?

  Now, if you've been paying any attention at all to Freakonomics Radio over the years, you know this is a surefire way to gather some not so realistic or at least not so robust data. And so, as Richard Kahn said, it can be a real challenge to run a really convincing nutrition study.

• 8:58Speaker 07

  Because people do not want to participate, do not want to alter their diet patterns for a long time, and they don't comply with the regimen of the or the instructions in the randomized trial.

• 9:09Stephen J. Dubner?

  Now, if we could take a few thousand people and randomize them and then control every single thing they ate and drank for a few years, that'd be great. But absent that, we do our best. We look for data. We ask questions, starting here. So as a public health official in New York and at the national level, you've tried to stem AIDS and TB and pandemic flu. You've tried to prepare the public for potential bioterror attacks. How, in light of those dangers, would you rank, let's say, the consumption of sugar?

• 9:50Speaker 10

  Well, they're very different threats. But I think we have to recognize that while acute public health crises, you know, really demand all of our attention and get a lot of response, that How we live, what we eat, if we exercise, many aspects of our daily lives have the greatest impact on health and disease.

• 10:17Stephen J. Dubner?

  That's Margaret Hamburg.

• 10:19Speaker 10

  I am a medical doctor and a public health professional who has served in government at many levels over many years now, and most recently as the US FDA Commissioner.

• 10:33Stephen J. Dubner?

  I wanted to ask you briefly about some FDA definitions that when I read them, I have to say they are somewhere between comical and incomprehensible when the FDA defines food, food additives, drugs, and then substances generally regarded as safe. So those are the categories. Which of these definitions apply to sugar?

• 10:57Speaker 10

  Well, you know, I have to agree with you that many of the definitions are hard to penetrate.

• 11:04Stephen J. Dubner?

  I didn't mean to slam you. I assumed you didn't write them.

• 11:06Speaker 10

  No, no.

• 11:07Stephen J. Dubner?

  And there were 40 lawyers between whoever wrote them and the rest.

• 11:09Speaker 10

  Congress is responsible for some of it, and FDA lawyers for some of it. And of course, you know, many of these laws and regulations and guidances and definitions have evolved over many, many years.

• 11:25Stephen J. Dubner?

  Yeah.

• 11:26Speaker 10

  But it is complicated and confusing, and it's why, you know, there are almost as many lawyers as scientists at the FDA.

• 11:35Stephen J. Dubner?

  Like, for instance, the first, the very first thing, food. Number one, articles used for food or drink for man or other animals. So like, you were talking about how you could have a nutritious sounding sawdust. I can imagine that could easily fit within FDA regulations, FDA guidelines, then. If it were used for food.

• 11:56Speaker 10

  Yeah, I mean, it's really hard to answer a question like the one you just posed to me. I mean, sugar. Is intrinsic to many food products. So it's not going to be regulated in the same way that a completely exogenous additive to a food product can be regulated.

• 12:21Stephen J. Dubner?

  And but so technically, the categories under which sugar falls, however, are food additive and GRAS, regarded as safe and not food itself, correct?

• 12:33Speaker 10

  Well, this is my point, and I'm not going to answer your question because I don't have my lawyers here. But, um, no. I mean, you know, there's, there are sugars in fruits and vegetables. There are sugars in dairy products. There are sugars in various grasses that that people consume. So, you know, it's, it's intrinsic to the food product itself.

• 13:03Stephen J. Dubner?

  For instance, let's get back to chocolate milk for a minute. As we said, it's got 24 grams of sugar per one cup serving, more than some soda. But regular old milk without the chocolate has about 12 grams of sugar. It's naturally sweet from the lactose. And then there's the sugar that's added to many foods.

• 13:21Speaker 10

  Products that you think are actually very healthy, you know? Yogurt, the levels of sugar are astonishingly high. Things like barbecue sauce and spaghetti sauce and soup actually have much higher levels of sugar than you would ever imagine, not to mention, you know, the levels that are in, um, you know, pies and cakes and ice cream and things where you would expect to see sugar.

• 13:48Stephen J. Dubner?

  So how much sugar overall do we actually consume?

• 13:52Speaker 03

  So right now, we are about 60 to 65% over our limit, and that's average.

• 13:58Stephen J. Dubner?

  That's Robert Lustig.

• 14:00Speaker 03

  I'm a professor of pediatrics at the University of California, San Francisco School of Medicine. I'm also a member of their Institute for Health Policy Studies. My job is to try to treat obese children and now also alter the global food supply.

• 14:18Stephen J. Dubner?

  Hmm, easy picking the low hanging fruit for yourself, I see.

• 14:22Speaker 03

  Yeah, easier said than done on both counts.

• 14:25Stephen J. Dubner?

  The data vary. Again, this is nutrition science we're talking about, but the most recent estimates show that Americans consume between 20 and 30 teaspoons of added sugar per day. That's down a bit from our peak consumption sometime around the early 2000s, but Americans still consume more added sugar than anyone else. And this has turned Robert Lustig into one of the most outspoken sugar critics you will find. He came to this position over many years.

• 14:55Speaker 03

  I'm a pediatric endocrinologist. I take care of glandular hormonal problems in children. And I was doing that pretty seamlessly for a good two to three decades. And then the kids started getting fat on me. And the question was, you know, what's going on? So we started looking at what sugar did to the body. And what we realized was it caused this thing called insulin resistance and particularly in the liver. And so we started comparing what sugar did versus what alcohol did. And we realized, you know what? Sugar and alcohol do the exact same thing. And it makes sense that it should because after all, where do you get alcohol from? Fermentation of sugar.

• 15:38Speaker 03

  And so we were now seeing the diseases of alcohol without the alcohol. And so that started my, shall we say, advocacy in this field of obesity and public health.

• 15:54Speaker 07

  If you are indeed overweight or obese, you want to lose weight, the first place to start is to reduce sugar consumption.

• 16:03Stephen J. Dubner?

  That, again, is Richard Kahn, formerly of the American Diabetes Association.

• 16:08Speaker 07

  The reason being that we get plenty of energy from other carbohydrates. We don't have to rely on sugar to get our energy. And the second reason is that sugar itself does not come along with any other essential nutrients, vitamins, or minerals.

• 16:24Stephen J. Dubner?

  So you might think that Kahn and Lustig are in precisely the same camp, but there you'd be wrong.

• 16:30Speaker 07

  Well, there's no question that there is a real obesity epidemic throughout the world. So that, I think, is very real, and it's very important, and it's very serious, and it has clear adverse health consequences. In addition, that has led to, I believe has led directly to, a dramatic increase in the incidence of diabetes throughout the world. We first saw this in the United States. We've seen it in European countries. We're now seeing it in Asian countries. So diabetes is clearly a serious disease. It has quite serious complications, and that's a problem. So then the question becomes, what has caused the obesity epidemic?

• 17:16Speaker 07

  And that is, to use the euphemism, a $64,000 question.

• 17:23Stephen J. Dubner?

  There are many potential contributors to the rise in obesity.

• 17:27Speaker 07

  So there's been some evidence that with the increased use of psychotropic drugs, antidepressive drugs, drugs for schizophrenia and other mental disorders, those drugs tend to promote weight gain. Another possibility is that We've seen clearly smoking cessation in a large proportion of the population. And when people stop smoking, that's usually been associated with weight gain. So psychotropic drugs, smoking cessation, potential infections have been attributed to a rise in obesity.

• 18:06Stephen J. Dubner?

  There's also a lot of research arguing the rather obvious point that we consume more calories today than we used to for a lot of reasons. The relative low cost of food, the deliciousness of food, the availability of food, especially the availability of cheap, delicious, sweet food.

• 18:24Speaker 07

  Okay, so many people do believe that sugar consumption has been the cause, is the cause of our obesity epidemic and then subsequently diabetes. But I believe that the evidence for this is pretty weak.

• 18:39Stephen J. Dubner?

  When the city of San Francisco wanted to add warning labels to soda, Khan submitted an expert report on behalf of, among others, the American Beverage Association. He wrote, quote, "There is no scientific consensus that added sugar, including added sugar in beverages, plays a unique role in the development of obesity and diabetes."

• 19:01Speaker 07

  So if we look as an analogy, for example, to cigarette smoking and try to make the link between sugar and obesity or diabetes and cigarette smoking to cancer and say, well, okay, what's the differences?

• 19:16Stephen J. Dubner?

  Okay, what are the differences?

• 19:18Speaker 07

  In the cigarette smoking realm, the lowest smoking rate produced an enormous incidence of lung cancer. And the highest rate of smoking was just simply off the charts in terms of the likelihood of developing lung cancer. Conversely, with sugar consumption, it's less than a twofold increase at the highest levels.

• 19:44Stephen J. Dubner?

  This gets into tricky territory. As Khan says, some studies do find a twofold increase in diabetes at the highest rate of sugar consumption, but other analyses, including one by Robert Lustig, argue that it's considerably higher. That said, the relationship between sugar and obesity is nowhere near as strong as the relationship between smoking and lung cancer. According to the National Institutes of Health, even light smoking results in a ninefold increase.

• 20:15Speaker 07

  The next one is something called temporality. In other words, is there an association in time between sugar consumption and obesity? So that held pretty true from about 1985 to the year 2000, where there was, as obesity levels went up, sugar consumption went up. But thereafter, starting in the year 2000, even to today, sugar consumption has declined somewhere around 15 to 20%, whereas obesity rates continue to rise. We don't see that at all with smoking, the analogous situation. Cigarette smoking rises, cancer rises. Cigarette smoking declines, cancer declines.

• 20:57Stephen J. Dubner?

  This, of course, doesn't mean that sugar doesn't contribute to obesity, just that, again, the relationship isn't so definitive. Khan points to another difference between smoking and sugar.

• 21:08Speaker 07

  In cigarette smoking, we found a link between cigarette smoking and cancer in every population, every ethnicity, both genders, all kinds of tobacco use, and even in bystanders. Conversely, with sugar, we don't have that consistency whatsoever.

• 21:27Stephen J. Dubner?

  For instance, some studies show a strong relationship between weight gain and sugar-sweetened beverages, SSBs, but that relationship is most consistent when the SSBs are consumed in addition to a person's regular diet. So the problem might simply be the extra calories, not the sugar per se. Could also be that people who drink a lot of sugary drinks do other things that lead to weight gain. There's also the fact that, as Richard Kahn said earlier.

• 21:57Speaker 07

  In general, nutrition studies are not very robust compared to many other fields in biological science. In sugar consumption, most of them, there have been either no controls, a very small number of subjects, they've only lasted for days or weeks at the most. And so the experimental studies have not been robust.

• 22:20Stephen J. Dubner?

  So in Kahn's view, the science on sugar is not settled, which means that the notion of regulating sugar is, at best, premature.

• 22:30Speaker 07

  I don't think that there's any absolute amount of sugar that we should be under in our consumption. I think that it all relates to eating a well-rounded diet.

• 22:41Stephen J. Dubner?

  To Robert Lustig, meanwhile, the time for regulation is now.

• 22:49Stephen J. Dubner?

  So this episode was inspired by a listener who wrote in to say, essentially, if sugar is as bad for us as a lot of people are now saying it is, why isn't it regulated the way other potentially harmful substances like alcohol or tobacco are regulated? So how do you answer that question?

• 23:09Speaker 03

  Well, the public health community has identified four separate criteria that are needed to be fulfilled before a substance can be considered for regulation. Those four are: number one, ubiquity, that is, can't get away from it. Number two, toxicity, that's dangerous. Number three, abused, that increased consumption is inherent in the molecule itself. And finally, number four is externalities, that is, your consumption hurts me. Now, alcohol, tobacco.

• 23:48Speaker 03

  Morphine and heroin, you know, clearly meet these four criteria. And so the question is, does sugar meet them? And the answer is, yes, it does. Absolutely.

• 23:58Stephen J. Dubner?

  Okay, let's look at those four criteria for sugar. Ubiquity? That's pretty much a no brainer. What about toxicity? Lustig's hypothesis has to do with how the body handles fructose.

• 24:10Speaker 03

  So when you consume dietary sugar, the glucose molecules can go anywhere in the body. Only about 20% hit the liver. But the fructose molecules have to be handled in the liver because there's a specific transporter called the Glut5 transporter. It is only in the liver. So when you consume a soda, you are flooding your liver and your liver basically can't handle the flood. And the liver has no choice but to turn that fructose into liver fat. And it's that liver fat that causes the chronic metabolic disease. And we have the data now that demonstrates that it's the liver fat made from dietary

• 24:50Speaker 03

  sugar that is at the nidus, at the beginning of type 2 diabetes, heart disease, fatty liver disease. And we're starting to ferret out the links between dietary sugar and cancer and dementia as well.

• 25:06Stephen J. Dubner?

  But I know there's other research that says that the toxicity argument may be overstated, that it's a, you know, not an acute toxin maybe, but a chronic one.

• 25:14Speaker 03

  Sure. You are absolutely right that sugar is not an acute toxin. So chronic toxins are still toxins, even though they don't make you keel over and die. Is benzene a toxin? We regulate it as such.

• 25:27Stephen J. Dubner?

  Yep.

• 25:28Speaker 03

  Benzene doesn't kill you acutely.

• 25:30Stephen J. Dubner?

  What about alcohol?

• 25:30Speaker 03

  So alcohol is both. It's an acute toxin, so, I mean, you can basically die on a bender. Or it's a chronic toxin, you can fry your liver. It's both. The point is that the FDA regulates acute toxins because it's in their charter, the Food, Drug and Cosmetics Act of 1938. Very specifically, it does not say anything about chronic toxins. And so the FDA does not regulate chronic toxins.

• 25:58Stephen J. Dubner?

  Criteria number three for regulation, the potential for abuse.

• 26:03Speaker 03

  It turns out that there is no biochemical reaction in any vertebrate on the planet that requires dietary fructose. Now, it happens to be sweet. It happens to signal our brain reward centers that we like this stuff. We happen to crave it. We happen to really enjoy it and a little too much. And in fact, now we have data that shows that it just happens to be addictive as well.

• 26:32Speaker 11

  So the question about whether sugar can meet the criteria for an addiction or an abuse substance is something that I've been studying for many years now. It's something that I think has become of interest to a lot of people.

• 26:43Stephen J. Dubner?

  That's Dr. Nicole Avina. She is a research neuroscientist at the Mount Sinai School of Medicine in New York.

• 26:50Speaker 11

  The way in which we've been studying this and the way in which others have studied this is to use these DSM criteria for addiction. And basically to ask the question, can sugar, when it's consumed in excess, produce some of these behavioral indications and neurochemical indications that you would typically see with a substance of abuse?

• 27:09Stephen J. Dubner?

  The DSM is the Diagnostic and Statistical Manual of Mental Disorders. It defines addiction or substance abuse along four main criteria: impaired control, social impairment, risky use, and pharmacological indicators like tolerance and withdrawal.

• 27:27Speaker 11

  You certainly don't need to meet all of them, and many people who are addicts don't meet all of those criteria, but you do need to meet a certain number of them for a protracted period of time. And what the research has suggested in both animal models and in clinical studies is that, in fact, yes, we do see that the criteria for addiction, as we classically define it in the DSM, can be met when the substance of abuse is in fact a sugar or in fact a palatable food in many cases. And so we see evidence of binging, we see evidence of withdrawal, evidence of craving. We also see changes in the brain.

• 28:05Stephen J. Dubner?

  Now, it's worth pointing out that some of the most troubling studies are animal studies, which can be problematic on two fronts. One, the lab animals aren't people, so they process sugar differently. And two, the doses of sugar the animals receive in the lab are often so large as to not be comparable to what most people would consume. Moreover, sugar isn't the only thing we consume that has addictive qualities. Pizza and french fries are also at the top of the list. So, how well does this emerging model of sugar addiction line up to the addictive criteria for the sort of drugs that we do regulate?

• 28:41Speaker 11

  It's a difficult question because I do think that sugar is safe when it's used in moderation. But the problem is that I think that most people are unaware of how much sugar they're consuming. And also, if the data suggests that the sugar is producing addictive-like changes in the brain, then now we're talking about something very different because if you're starting to now no longer be able to have full volitional control over your decision to eat or not eat the sugar, then that becomes, I think, a different type of discussion.

• 29:12Stephen J. Dubner?

  The fourth criteria for regulation that Robert Lustig was telling us about? Externalities.

• 29:17Speaker 03

  That is, your consumption hurts me.

• 29:20Stephen J. Dubner?

  A classic case of externalities is auto travel. Every time you drive, it costs me something, whether I'm driving or not. More pollution, more congestion, more risk of accident. We share all those costs regardless of my actions.

• 29:35Speaker 03

  So, the question is, does this fit for sugar? I mean, do I have anything to say about your consumption? And the answer is, yeah, you're costing me obesity-related health care, whether I'm obese or not, because of your obesity. It's economic, but it's real. Because 62% of all the health care costs in this country are shouldered by the federal government. So, damn right, we share it.

• 30:01Stephen J. Dubner?

  Coming up on Freakonomics Radio, okay, having heard what we've heard about sugar, how would you think about regulating it?

• 30:07Speaker 11

  Not sure that I can really embrace, you know, the proposal to regulate sugar in that way.

• 30:15Stephen J. Dubner?

  And we'll find one sugar fact that everyone agrees on.

• 30:19Speaker 03

  I mean, sugar's celebratory. Sugar's, you know, fun.

• 30:26Stephen J. Dubner?

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• 31:10Stephen J. Dubner?

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• 31:35Stephen J. Dubner?

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• 32:13Stephen J. Dubner?

  It's hard to find anyone who doesn't like sugar, and nearly just as hard to find anyone who doesn't think that they're having too much of it.

• 32:23Speaker 12

  I really like sugar. I know it's bad for you, but I, I don't know, I like it.

• 32:29Speaker 13

  Well, right now, I am staying away from sugar. So right now, I'm just trying to get, trying to eat better, have a better diet.

• 32:37Speaker 14

  I've tried to cut back on it, but I've never given it up. I think it tastes delicious in the right thing. And I think that at this point, it's probably an addiction that our body, my body just needs to have. So that, yeah, I've never tried to give it up, nor will I give it up anytime soon.

• 32:57Speaker 15

  I've definitely eaten too much of it because I had a sleepover at my friend's and for breakfast, we had lollies.

• 33:04Stephen J. Dubner?

  It wasn't always thus.

• 33:06Speaker 06

  Sugar started out as a minor commodity that was used for medicine and for spice up until, oh, I would say into the Middle Ages.

• 33:17Stephen J. Dubner?

  That's Elizabeth Abbott. She teaches history at Trinity College, University of Toronto. She's the author of Sugar: A Bittersweet History. She says the debate over what sugar is, a food, a drug, or something in between, is not new.

• 33:31Speaker 06

  Thomas Aquinas, way back in the 13th century, and he pronounced sugar a medicine. He said, "Though nutritious in themselves, sugared spices are nonetheless not eaten with the end in mind of nourishment, but rather for ease in digestion. Accordingly, they do not break the fast any more than the taking of any other medicine."

• 33:52Stephen J. Dubner?

  One reason sugar was welcome in medicine was because a lot of medicine tasted terrible. It was a combination of bitter roots, animal feces, even bits of corpse. So yeah, a spoonful of sugar really does make the medicine go down. Outside of medicine, however, sugar was decidedly aristocratic.

• 34:13Speaker 06

  For example, Persia, or Iran today, it was very, very popular among the elite. And they are the ones that started this, this trend, this architecture of sugar. And they would make beautiful sculptures, often like, for example, life-sized trees.

• 34:34Stephen J. Dubner?

  Sugar was costly and sugar was rare, but the sugar trade began to grow, built on the back of the slave trade.

• 34:42Speaker 06

  So by 1680, sugar cost only half what it had in 1630.

• 34:50Speaker 06

  That was thanks to slavery. By 1700, the percentage of imported foodstuffs, including sugar, had more than doubled. And they quadrupled between 1700 and 1740. And England and Wales consumed 60 times more, six zero times, more sugar, though their populations did not quite double.

• 35:13Stephen J. Dubner?

  Abbott argues that it was the Industrial Revolution that helped turn sugar into an everyday thing.

• 35:18Speaker 06

  People started going from their farms and so on into cities and into factories. And they couldn't go home for lunch because they had, you know, maybe a 15-minute break. So sugared tea and a bun or some sort of thing like that with, often with jam on it, was offered instead, and that was what popularized it. It's said that it fueled the Industrial Revolution because sugared tea, and it would be really sugary, has calories, and they're not nutritious, but they are units of energy.

• 35:54Stephen J. Dubner?

  The sugar boom helped create another boom that we're still living through.

• 35:59Speaker 06

  They had a lobby that was extremely powerful. I think that we could say all the big, heavy industrial lobbying probably stems from the success of the sugar lobby.

• 36:10Stephen J. Dubner?

  That's right. It wasn't enough to benefit from slave labor and huge demand for their product.

• 36:17Speaker 06

  The sugar plantations were profitable, not just because of the demand, but largely because of how they were politically strong. If they had failures, if they had hurricanes, if they had bad crops, which they often did, they could keep the price, they could get Parliament to help them out with good legislation and tariffs and so on that would favor them. And by the way, the sugar lobby is still a very important one, and it has a lot of weight still, and it now is sort of an alliance of cane sugar planters and beet sugar planters. And they do get together to lobby when they feel that their interests are at stake.

• 37:01Stephen J. Dubner?

  It was only recently uncovered that in the 1960s, the sugar industry paid three Harvard scientists to write a review that shifted the blame for heart disease from sugar to saturated fat. Much more recently, Coca-Cola spent millions of dollars on research arguing that the real culprit in obesity is lack of exercise, not sugary drinks. So you can't blame people for being confused, maybe conflicted, about the degree to which sugar is a health risk. I brought this up with Robert Lustig. Let me just ask you right now, we're talking in the year 2017, a lot of people now are convinced that the US government and many others erred terribly in declaring fat to be the enemy, or at least the enemy of the scope that it was declared to be, to be the

• 37:44Stephen J. Dubner?

  cause of obesity. And that, and many people now believe, as you argue, that sugar is a much bigger villain. How do we know you're not the guy that's wrong this time? That you're not just another, perhaps even well-intentioned, big-brained do-gooder who's making a massive mistake?

• 38:04Speaker 03

  An awfully good question. So this is known as the pessimistic meta-induction theory. And what it says is, well, everything we knew 10 years ago is already wrong, and everything we know today will be wrong 10 years from now. So why should we do anything differently when we know that whatever it is that we believe today will end up being wrong? So if you play that game, then you might as well never do any research, never do anything at all, and just basically live with the current dogma.

• 38:37Stephen J. Dubner?

  There's also the confounding fact, as pointed out by former FDA Commissioner Margaret Hamburg, that a lot of time you're eating sugar, even when you don't know you're eating sugar.

• 38:47Speaker 10

  Things like barbecue sauce and spaghetti sauce and soup actually have much higher levels of sugar than you would ever imagine.

• 38:54Stephen J. Dubner?

  Talk to me for a moment about the SMART Choices Program and what the FDA did there.

• 38:59Speaker 10

  Well, the SMART Choices Program was an effort spearheaded by industry. A number of major food-producing companies came together to create a system where you would give different scores to different aspects of the nutritional value of a product, and the total number would then...

• 39:27Speaker 10

  Either give you the green check of a smart choice or not.

• 39:32Stephen J. Dubner?

  The title I gather, the name I gather was an industry name, yes? Not a regulatory name.

• 39:37Speaker 10

  Right, exactly. I mean, the problem with it was that you could score adequately high to get that green smart choice check without the food truly reflecting, I think, what any sensible nutrition expert would view as a healthy, smart choice. You know, some of the products that got the smart choice label, you know, were very high in sugar, you know, over 40% sugar. We joked that you could practically take sawdust, and if you added enough nutrients

• 40:19Speaker 10

  to it and the fiber of sawdust, you know, you could have it labeled as a healthy choice, a smart choice.

• 40:26Stephen J. Dubner?

  Right, so how long did that last?

• 40:29Speaker 10

  So it was, it was out there for a little while. We expressed our concerns to the group that had put this together and was implementing it, and I think they, they listened and understood, and they decided voluntarily to withdraw the program. And there have been a number of efforts to look at other strategies for providing consumers with important information about foods. The Nutrition Facts label, of course, is one important aspect, but the Nutrition Facts

• 41:09Speaker 10

  label that's on, you know, most processed foods and beverages in this country was first put into place now more than two decades ago.

• 41:21Speaker 10

  But then it was never updated. And so when I was commissioner, we decided it really did need to be updated to reflect both deeper understandings about how people eat, you know, serving size, for example, but also advances in nutrition science. And so we embarked on a process to update it. I think the most important contribution that this updated nutrition facts label provides is in the area of added sugar.

• 41:50Stephen J. Dubner?

  As I understand it, food and beverage companies are already adjusting their products to consider the new labeling. Was that your intention?

• 42:03Speaker 10

  Well, absolutely. One of the goals of putting out that information is to encourage companies to reformulate foods towards, you know, healthier products. And we've certainly seen that happen as we've moved towards this, the implementation of this new nutrition facts label. Stonyfield Yogurt, I believe, just recently decided to significantly reduce levels of sugar before the new facts label is actually in place. FDA, in some ways, has the opportunity to use both the carrot and the stick, you know, knowing that we

• 42:45Speaker 10

  could do mandatory guidelines on certain things. It often encouraged industry to work with us to come to voluntary approaches. But there's no doubt that, you know, there are tensions.

• 43:00Stephen J. Dubner?

  So Robert Lustig, he, like several others in that camp, argue that that sugar should be regulated substantially because it meets criteria for substances that should be controlled or regulated: unavoidable, toxicity, potential for abuse, and negative impact on society. So I'm curious what your thoughts are on sugar fitting those criteria, whether you think that's even a useful framework.

• 43:27Speaker 10

  I think that we need to reduce excess sugar in our diets and in the products that we consume. I think consumers need more education and information, but I'm not sure that I can really embrace, you know, the proposal to regulate sugar in that way.

• 43:47Stephen J. Dubner?

  Because it would be too overreaching, because it would be too difficult. Why?

• 43:55Speaker 10

  It's a complex area to regulate in that sugars, you know, are intrinsic components of many foods, many foods which should be part of a balanced nutritious diet. Fruits and vegetables and dairy products are good examples. And I think that, you know, some of the concerns that have been raised, you know, may not be fully grounded in the best possible science.

• 44:27Stephen J. Dubner?

  Not fully grounded in the best possible science. That, you'll recall, was Richard Kahn's main objection to the idea of regulating sugar. But there's another one, too.

• 44:38Speaker 07

  Okay, so if you reduce it, or get rid of it, or put policies and laws regulating it, what good is it going to do? And we have no clue, no real good evidence, that it's going to do any good whatsoever. And therefore, unintended consequences become a very important factor.

• 45:01Stephen J. Dubner?

  Robert Lustig, meanwhile, is, as you have likely figured out by now, in favor of just about any kind of sugar regulation you can imagine. Taxes, for instance, and price hikes, both of which worked to reduce cigarette smoking and are already being used on sugary drinks in a few places.

• 45:18Speaker 03

  Well, the modeling studies that have been done suggest that you have to raise the price of a can of soda by about 20% in order to see any meaningful reduction in consumption.

• 45:29Stephen J. Dubner?

  Lustig is also in favor of limiting the availability of sugar, removing vending machines from schools, for instance. Also banning TV commercials for products with added sugar. Also, getting rid of subsidies.

• 45:43Speaker 03

  Subsidies for food make no sense, because subsidies distort the market.

• 45:48Stephen J. Dubner?

  Okay, one last question, perhaps ridiculous or impossible, but

• 45:55Stephen J. Dubner?

  Let's say we're in a world where you could edit genes quite easily, and it seems we're not that far from it. Whether we're talking about a 50-year-old person or a zygote, how would you consider editing the genes related to what seems to be a craving, perhaps even dangerous craving for sugar?

• 46:14Speaker 03

  Well, that's a really tough question. We don't want to turn off our reward system entirely. If we do, we actually get into trouble. We actually did this. We did this experiment with a medicine back in the early 2000s. The medicine was called remonaban. And what it was, was it was the anti-marijuana medicine. It blocked the endocannabinoid receptors in the brain. And by doing so, reduced reward for alcohol and for food. And in fact, people who took remonaban lost a fair amount of weight, and it looked very promising. Until we started looking at the phase three data and started realizing

• 46:57Speaker 03

  that a lot of these people became severely depressed, and in fact, many of them committed suicide. And we didn't realize it until we did those phase three trials, and it was never approved here in the United States. Bottom line is, if you take away reward, you take away the reason for living. So being careful about gene editing our reward system.

• 47:20Stephen J. Dubner?

  Most of the regulatory measures that Robert Lustig would like to see around sugar lie somewhere between unlikely and impossible, at least for now. In any case, we asked a bunch of people in Times Square what they thought about it. Most definitely to ban sugar. Sugar is one of the best things in the world. I don't think it should be taxed either.

• 47:40Speaker 16

  Probably a tax, but not a ban. Just because I don't think a ban would work very well, but maybe a tax would have people think about what they're buying a little bit more.

• 47:50Speaker 17

  I feel like that would backfire really bad because like, look at the back in the Revolutionary War. British put a tax on tea, and people didn't really like that too much, so.

• 48:00Speaker 15

  I would probably cry because I love sugar.

• 48:05Stephen J. Dubner?

  A love of sugar seems, from what we can tell, pretty universal, including among the scientists and doctors we've been speaking with today. From Richard Kahn, formerly of the American Diabetes Association.

• 48:19Speaker 07

  One clear thing that comes to mind is just pleasure. I mean, sugar is enjoyable to eat. It's part of our culture. It's keeping our community together, our families together.

• 48:29Stephen J. Dubner?

  To Margaret Hamburg, former FDA commissioner.

• 48:34Speaker 10

  Well, I will admit to having a sweet tooth.

• 48:38Speaker 10

  I do enjoy oatmeal cookies, I'll tell you, with my particular vice.

• 48:44Stephen J. Dubner?

  To the most anti-sugar one of all, Dr. Robert Lustig.

• 48:49Speaker 03

  I mean, sugar's celebratory. Sugar's, you know, fun. Sugar's, you know, apple pie. Sugar is, you know, reward, but once a week.

• 49:08Stephen J. Dubner?

  Coming up next time on Freakonomics Radio. If you were a judge on Shark Tank, what would you make of this pitch?

• 49:14Speaker 18

  I'd like to open a new kind of grocery store. We're not going to have any branded items. It's all going to be private label. We're going to have no television advertising and no social media whatsoever, no Facebook, no Twitter. We're never going to have anything on sale. We're not going to accept coupons. Would you invest in my company?

• 49:34Stephen J. Dubner?

  And what if I told you that this grocery store not only already exists, but that it's crushing the competition?

• 49:39Speaker 18

  They not only are at the top of the industry, but they're at the top by a wide, wide margin.

• 49:44Stephen J. Dubner?

  A look at the economics behind one of the most unconventional and beloved companies in America. That's next time on Freakonomics Radio.

• 49:55Stephen J. Dubner?

  Freakonomics Radio is produced by Stitcher and Dubner Productions. This episode was produced by Stephanie Tam with help from Eliza Lambert and Matt Fidler. Our staff also includes Alison Kreglo, Greg Rippon, Alvin Melathe, Harry Huggins, and Zach Lepinski. Our theme song is "Mr. Fortune" by The Hitchhikers. You can subscribe to- To Freakonomics Radio on Apple Podcasts or wherever you get your podcasts. The entire archive is available on the Stitcher app or at Freakonomics.com, where we also publish transcripts, show notes, and more. If you want the entire archive ad-free, plus lots of bonus episodes, go to StitcherPremium.com/Freakonomics.

• 50:34Stephen J. Dubner?

  We can be found on Twitter, Facebook, LinkedIn, or via email at [email protected]. Freakonomics Radio also plays on many NPR stations. Check your local station for details. As always, thank you for listening.

• 50:57Speaker 11

  Stitcher.

• 51:03Stephen J. Dubner?

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• 51:35Stephen J. Dubner?

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• 52:06Stephen J. Dubner?

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• 52:37Speaker 19

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